ArticlesSudden unexplained infant death in 20 regions in Europe: case control study
Introduction
The remarkable increase in sudden unexplained infant death (SIDS) rates recorded, especially in Norway1 and in several other countries,2, 3, 4 towards the end of the 1980s prompted large scale case-control studies that were set up during 1992 in Scandinavia,5 Ireland,6 England, and Germany.7, 8 The succeeding reduction in SIDS rates, led by the Netherlands,9 which occurred in some countries necessitated a reassessment of risk factors for the syndrome because, despite the reductions, SIDS was still a major cause of infant mortality after the first week of life. These investigations all included similar questions about most previously established risk factors. At the 1992 meeting of the European Society for the Study and Prevention of Infant Death, participants suggested the potential value of integrated data from these and other studies, which led to the founding of the European Union Concerted Action on SIDS (ECAS) in January, 1994. Our main aims were to combine data from across Europe and thereby establish risks currently associated with previously suspected risk factors, especially those associated with infant care practices, assess whether levels of risk vary across Europe, and investigate the extent to which risk factors interact.
Section snippets
Methods
In addition to continuing research, new studies that all followed the same ECAS protocol were set up in 12 centres, six of which were in eastern Europe. Therefore, data were derived from case-control studies of SIDS of varying duration done in 20 centres between September, 1992, and April, 1996. Denmark, Norway, and Sweden, which comprised the Nordic study, were counted as three centres, as were the three regions (Yorkshire, Trent, and South West)that made up the first 2 years of the
Results
20 European centres assembled data for 745 cases of SIDS and 2411 controls (table 1). 12 new centres using the ECAS protocol contributed 138 (19%) cases. For the 20 centres, SIDS incidence rates at the time of the studies ranged from 0·17 per 1000 in Hungary to 1·3 per 1000 in Nordrhein-Westfalen (median 0·6 [IQR 0·4–0·7]). Seasonal rates varied by 13·6% (3·3%–26·1%) either side of the mean (p=0·018) with peak incidence close to the shortest day. Although frequency was higher at the weekend
Discussion
Across the centres, the ORs for sleeping prone was negatively correlated with the prevalence of this sleeping position.17 Thus, our OR was much higher than noted in earlier investigations when sleeping prone was much more common.
Adjusted OR for position the infant was last left inside versus supine—was not significant. However, the side position was much less stable than the back position. During the controls' reference sleep, 61% who were left on their side moved compared with 12% controls
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